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PAINKILLER MISUSE IN FOOTBALL, PART OF THE JOB? FEATURE / DANIEL READ, AARON C.T. SMITH & JAMES L. SKINNER Introduction If boxing is the ‘hurt game’ then professional football has surely become the ‘pain game’. Individualism and a competitiveness are deeply embedded within professional football and while these values make for dramatic sport experiences, it also means that players are treated as commodities that can be retired and discarded once their physical capabilities are exhausted. In order to remain employable for as long as possible, professional footballers endure significant physical trauma that leaves them bruised, battered, and vulnerable to varying levels of post-game, and ultimately, post-career, stress. Of course, some commentators might argue that at least a small percentage of professional footballers are exceptionally well rewarded for their pain and that the former description of big-time sport is alarmist and exaggerated. However, our research exposes the ways in which painkilling drugs can be seen as tools that sport managers, coaches, scientists, and players use to maximise game time and longevity. So, while the presumption that players should be able to manage their bodies in ways that are consistent with their own beliefs about
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the practice and performance of sport, we have confronted the disconcerting possibility that players need protection from imposed drug misadventures and misjudgements. Painkiller Misuse in Football In recent years, numerous high-profile retired footballers have admitted to painkiller misuse during their careers that led to long-term harm (Read et al., 2022). The therapeutic use of analgesic substances and injections is common practice in football to enable players to compete through minor injuries, however, sport physicians have raised concerns about painkiller (mis)use without medical need and/or supervision in football (Correctiv, 2020; Tscholl & Dvorak, 2012). Our research aimed to understand the motivations for painkiller misuse from a relational perspective by considering the interaction between player experiences and their working environments. In exposing the pressures footballers are under to use painkilling drugs, we have been able to identify a set of risk factors sports medicine practitioners can employ to locate and assist players vulnerable to misuse in order to reduce harm and prevent long-term damage.
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Sport clubs, no matter the performance level, like to see their athletes available for selection as soon as possible after injury, meaning overthe-counter painkillers are widely used to relieve discomfort and enable increased range of movement. Additionally, painkilling drugs may offer temporary performance enhancement although effects vary by substance (Holgado et al., 2018). As a result, perhaps unsurprisingly, painkiller misuse is common across endurance, collision, and combat sports (Harle et al., 2018) with these athletes reporting higher levels of painkiller use relative to the general population (Alaranta et al., 2006). To complicate matters, given the clandestine nature of painkiller misuse, limited data are available specifying the extent of the problem in football. Reports from Germany have highlighted that both professional (Trinks et al., 2021) and amateur footballers (Correctiv, 2020) are engaging in prophylactic painkiller use without medical need. Likewise, medication reports provided by team doctors covering the 72 hours before kick-off at World Cup matches indicated that painkiller use is common at the highest level of the game (Oester et al., 2019). Figure 1 shows that of the 736 players from 32
